Perioperative management of patients with adrenal insufficiency

P.V. Dunts1,2, O.E. Li2, V.B. Shumatov1

1 Pacific State Medical University, Vladivostok

2 Regional Clinical Hospital, Vladivostok

For correspondence: Pavel V. Dunts, PhD, Chief of the Department of Anesthesiology and Reanimatology of the Regional Clinical Hospital № 2, Assistant Professor of the Department of Anesthesiology and Reanimatology, Pacific State Medical University; e-mail:

For citation: Dunts PV, Li OE, Shumatov VB. Perioperative management of patients with adrenal insufficiency. Alexander Saltanov Intensive Care Herald. 2019;1:58–65.

DOI: 10.21320/1818-474X-2019-1-58-65

The article is a review of modern publications covering the issues of adrenal insufficiency in patients in the periopreparative period. The article covers the issues of epidemiology, etiology and pathogenesis, presents algorithms for examining patients with adrenal insufficiency. Topical issues such as the perioperative management of patients receiving steroid hormone replacement therapy, depending on the incidence of the operation and the problems of the hypoadrenal crisis are considered.

Keywords: adrenal insufficiency, perioperative management, anesthesia, hypoadrenal crisis

Received: 24.12.2019


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Estimation of Dexketoprofen Effectiveness for Preemptive Analgesia in Patients with a Fracture of the Hip after Combined Trauma During Femoral Osteosynthesis

O.V. Voennov1, M.V. Karelsky1, A.O. Trofimov1,2, G.V. Kalentev2

1 Nizhny Novgorod State Medical Academy, Russian Federation, Nizhny Novgorod

2 Nizhny Novgorod Regional Clinical Hospital n.a. Semashko, Russian Federation, Nizhny Novgorod

For correspondence: Karelsky Mikhail Viktorovich, post graduate student of the Department of Anaesthesiology and Reanimatology Nizhny Novgorod State Medical Academy, Russian Federation, Nizhny Novgorod; e-mail:

For citation: Voennov OV, Karelsky MV, Trofimov AO, Kalentev GV. Estimation of Dexketoprofen Effectiveness for Preemptive Analgesia in Patients with a Fracture of the Hip after Combined Trauma During Femoral Osteosynthesis. Intensive Care Herald. 2017;4:29–35.

We have studied the effectiveness of dexketoprofen for preemptive analgesia in patients with a fracture of the hip after combined trauma during femoral osteosynthesis. We examined 120 patients of both sex. The patients were divided into 2 groups of 60 people depending on the use of preemptive analgesia. After that the group of 60 persons were divided into groups of 20 patients, depending on the type of anesthesia. Group 1A — inhalation anesthesia (IA). Group 1B — regional anesthesia (RA). Group 1С — total intravenous anesthesia (TIA). Group 2A — inhalation anesthesia (IA) and preemptive analgesia with dexketoprofen. Group 2B — regional anesthesia (RA) and preemptive analgesia with dexketoprofen. Group 2С — total intravenous anesthesia (TIA) and preemptive analgesia with dexketoprofen. All patients were provided with blocked intramedullary femoral osteosynthesis in 3–5 days after the trauma. Postoperative analgesia was provided with tramadol and trimeperidine. The study consisted of the following steps: 1st — before the surgery, 2nd — at the beginning of the operation, 3rd — after the transfer to the hospital ward, 4th — 24 hours after the surgery. We studied pain expression using the visual analog scale, hemodynamics, blood cortisol levels. After using dexketoprofen all patients had a more favorable pain severity dynamics, less blood cortisol levels, less blood pressure and heart rate in the early postoperative period.

Keywords: postoperative pain syndrome, combined trauma, anesthesia, postoperative analgesia, dexketoprofen, preemptive analgesia

Received: 02.08.2017


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Anesthesia in Patients with Concomitant Diseases of the Central Nervous System: a Literature Review

N.V. Trembach

Kuban State Medical University of Ministry of Health of Russia, Krasnodar

For correspondence: Trembach N.V. — PhD, Assistant of the Department of Anesthesiology, Reanimatology and Transfusiology of Kuban State Medical University, Krasnodar; e-mail:

For citation: Trembach NV. Anesthesia in Patients with Concomitant Diseases of the Central Nervous System: a Literature Review. Intensive Care Herald. 2017;3:19–34.

Chronic congenital and acquired diseases of the central nervous system are a heterogeneous group of diseases, the etiology and pathogenesis of which is quite diverse and associated with the damage to the brain and spinal cord. Such diseases include the consequences of acute cerebral circulation disorders, intracranial hypertension, Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, epilepsy, multiple sclerosis, the consequences of poliomyelitis, amyotrophic lateral sclerosis, syringomyelia, the consequences of spinal cord injury. The review presents approaches to preoperative assessment and preparation, the choice of anesthesia and anesthetics, and the tactics of myoplegia in patients with the diseases of the central nervous system.

Keywords: anesthesia, concomitant diseases of the central nervous system

Received: 10.06.2017


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Perioperative Management of Patients with Diabetes Mellitus

Y.P. Malyshev1, I.B. Zabolotskih1, K.M. Lebedinskii2, M.I. Neymark3, P.V. Dunts4

1FGBOU HE «Kuban State Medical University» Ministry of Health of the Russian Federation, Krasnodar

2FGBOU HE «Northwest State Medical University named I.I. Mechnikov» Ministry of Health of the Russian Federation, Saint-Petersburg

3FGBOU HE «Altai State Medical University» Ministry of Health of the Russian Federation, Barnaul

4FGBOU HE «Vladivostok State Medical University» Ministry of Health of the Russian Federation, Vladivostok

For correspondence: Malyshev Yuri Pavlovich — Ph.D., Professor, Department of Anesthesiology, Intensive Care and Transfusion FPC and PPP Medical University, «Kuban State Medical University» Ministry of Health of the Russian Federation, Krasnodar; e-mail:

For citation: Malyshev YP, Zabolotskikh IB, Lebedinskii KM, Neumark MI, Dunts PV. Perioperative Management of Patients with Diabetes Mellitus. Intensive Care Herald. 2016;4:41–51.

The article summarizes current understanding of the endocrine disorders caused by diabetes mellitus. Preoperative evaluation and assessment of patients with concomitant diabetes mellitus before anaesthesia are presented. Key points include preoperative period optimization, intraoperative management, prevention of urgent diabetes complications, blood glucose correction for urgent and elective surgery.

Keywords: diabetes mellitus, diagnosis, management of the patient, anesthesia, intensive care, perioperative

Received: 10.08.2016


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Perioperative Management of Patients with Valvular Heart Disease

I.B. Zabolotskikh1, A.Zh. Bayalieva2, S.V. Grigor’ev1, M.Yu. Kirov3, K.M. Lebedinskiy4

1 Federal State Budgetary educational institution of higher education Kuban State Medical University of the Ministry of

Healthcare of the Russian Federation, Krasnodar

2 Kazan State Medical University, Kazan

3 Northern State Medical University, Arkhangelsk

4 Ilya I. Mechinkov North-Western State Medical University, Saint-Petersburg

For correspondence: Igor B. Zabolotskikh — MD, PhD, DSc, professor, head of the Department of Anaesthesiology, Reanimatology and Transfusiology of Kuban State Medical University; e-mail:

For citation: Zabolotskikh IB, Bayalieva AZh, Grigor’ev SV, Kirov MYu, Lebedinskiy KM. Perioperative Management of Patients with Valvular Heart Disease. Intensive Care Herald. 2016;3:55–69.

Perioperative management of patients with valvular heart disease is a serious problem, considering different hemodynamic changes depend on lesion of valves. Features of clinical and instrumental preoperative assessment of those patients reviewed. Recommendations on thrombosis prophylaxis, infectious endocarditis, intraoperative monitoring are given. Details on perioperative management of different frequent valvular diseases was described, include preoperative preparation, main anesthesia goals, choice of optimal anesthesia technique and drug.

Keywords: valvular heart disease, perioperative management, anesthesia


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The History of World and National Anesthesiology and Intensive Care at the Heart Transplantation

I.A. Kozlov1, 2, L.A. Krichevskiy1, 3

1 FGBNU «V.A. Negovsky Research Institute of General Reanimatology», Moscow

2 GBUZ MO «M.F. Vladimirsky Moscow Regional Research Institute», Moscow

3 GBUZ «City Clinical Hospital № 15 n.a. O.M. Filatov», Moscow

For citation: Kozlov IA, Krichevskiy LA. The History of World and National Anesthesiology and Intensive Care for Heart Transplantation. Intensive Care Herald. 2016;2:14–28.

The article describes the history of a heart transplant, focusing on anesthesia and resuscitation aspects of the procedure. Considered in detail the various stages of the development of this operation for over a hundred years. Scientific and practical process of development of heart transplantation presented in detail in the so-called pre-clinic period and during the implementation of this operation in the daily work of the cardio-surgical centers. The article made it possible to convey the drama and intensity of emotional inherent in the initial series of heart transplants in the clinic (until 1970). Through close contact with colleagues, the authors were able to promulgate the little known but extremely important facts and events in the history of the heart transplantation, called undeservedly forgotten names of anaestesiologists, intensivists, perfusionists, ensure the formation of cardiac transplantology in the world and in Russia.

Keywords: heart transplantation, anesthesia, history of medicine

Received: 13.06.2016


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The features of anesthesia in bariatric surgery

E.Y. Garbuzov, G.A. Ovsyannikov, S.G. Sherbak

City Hospital № 40, Saint-Petersburg

For correspondence: Evgenii Garbuzov — MD, head of Department of anesthesiology and intensive care of Saint-Petersburg clinical hospital № 40, Saint-Petersburg; e-mail:

For citation: Garbuzov EY, Ovsyannikov GA, Shcherbak SG. The features of anesthesia in bariatric surgery. Alexander Saltanov Intensive Care Herald. 2018;2:31–5.

DOI: 10.21320/1818-474X-2018-2-31-35

Nowadays obesity is a worldwide problem. Changes associated with the obesity commonly increase risks of perioperative complications that could be fatal. The increasing of fat tissue influences significantly on pharmacokinetic of intravenous drugs, nevertheless effects of inhaled anesthetics remain more predictable. Structural changes of upper airways, sleep apnea obstructive syndrome, cervical osteochondrosis reduce visualization in direct laryngoscopy. Frequency of difficult tracheal intubation in patients with body weight index more than 40 kg/m2 reaches 13–24 %. In some cases awake tracheal intubation is necessary, that changes a traditional induction plan. Morbid obesity patients have often cardiovascular diseases, respiratory system disorders and increased intra-abdominal pressure, therefore they need a differentiated approach for ventilation strategy for safe anesthesia. Knowledge of the pathophysiology of these changes allows to take measures to prevent serious complications. Nowadays in the general surgery department of the Saint-Petersburg City Hospital № 40 we perform two types of bariatric operations: sleeve — resection and gastric-bypass. In this article we have presented our experience of perioperative management of morbid obese patient for bariatric surgery.

Keywords: anesthesia, morbid obesity, bariatric surgery, laparoscopic surgery, difficult airways, inhaled anesthetics, monitoring of neuromuscular block

Received: 20.12.2017


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Perioperative management of geriatric patients. Project of clinical recommendations

I.B. Zabolotskikh1, E.S. Gorobets2 E.V. Grigoriev3, I.A. Kozlov4, K.M. Lebedinsky5, T.S. Musaeva1, A.M. Ovechkin6, N.V. Trembach1, V.E. Khoronenko6

1 Federal State Budgetary Educational Institution for Higher Education «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar

2 Blokhin Russian Cancer Research Centre, Moscow

3 Federal State Budgetary Educational Institution for Higher Education “Kemerovo State Medical University” of the Ministry of Healthcare of the Russian Federation, Kemerovo

4 Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy (“MONIKI”), Moscow

5 State budget institution of higher education “North-Western State Medical University named after I.I. Mechnikov” under the Ministry of Public Health of the Russian Federation, Saint-Petersburg

6 Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow

For correspondence: Igor B. Zabolotskikh — Doctor of Med. Sci., professor, head of the Department of Anesthesiology, Reanimatology and Transfusiology of the Kuban State Medical University; e-mail:

For citation: Zabolotskikh IB, Gorobets ES, Grigoriev EV, et al. Perioperative Management of Geriatric Patients. Project of Clinical Recommendations. Alexander Saltanov Intensive Care Herald. 2018;1:60–74.

DOI: 10.21320/1818-474X-2018-1-60-74

The need for surgical treatment in elderly patients arises four times more often than the population average. Due to the tendency to increase life expectancy, the number of elderly patients who underwent surgery increases, which requires an increase in the geriatric care, including surgical and anesthetic care. It is well known that in comparison with young patients, older subjects have a higher risk of developing adverse postoperative outcomes as a result of age-related decline in physiological functions, the presence of several comorbidities, polypharmacy, cognitive dysfunction and specific geriatric syndromes such as frailty. The presented recommendations generalize modern principles of perioperative management in patients of older age groups. Particular attention is paid to the peculiarities of preoperative examination, including the evaluation of geriatric syndromes, the choice of anesthesia method and the correct calculation of doses of drugs for anesthesia. Great importance at the present time made the role of cognitive status of older patients and post-operative cognitive dysfunction, which substantially affects the outcome of the disease. These recommendations include measures to assess cognitive status and prevent complications associated with cognitive impairment. Individualization of approach to management of geriatric patients is the basis of effective prevention of perioperative complications.

Keywords: geriatrics, anesthesia, perioperative period

Received: 12.03.2018


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Experience of the use of transverse abdominal plane (TAP) block during hernia repair in a high risk patients (clinical observation)

O.A. Makharin1,2, M.L. Skoblo2

1 Rostov state medical University, Department of anesthesiology and reanimatology, Rostov-on-Don

2 City hospital № 6, Rostov-on-Don

For correspondence: Oleg A. Makharin — MD, assistant of Department of anesthesiology and reanimatology of Rostov state medical university, Rostov-on-don; e-mail:

For citation: Makharin OA, Skoblo ML. Experience of the Use of Transverse Abdominal Plane (TAP) Block During Hernia Repair in a High Risk Patients (Clinical Observation). Alexander Saltanov Intensive Care Herald. 2018;1:75–8.

DOI: 10.21320/1818-474X-2018-1-75-78

Can we use TAP-block as a method of anesthesia during surgery, and if so, when? The number of patients with severe concomitant pathology is increasing every year. Such patients long-term taking a number of medications, including anticoagulants, which are limited the use of neuroaxial anesthesia techniques. Blockade of peripheral nerves under ultrasound guidance is a relatively safe method of pain relief that is gaining popularity. This article describes a clinical case of the use of TAP-block during hernia repair to the patient with severe cardiovascular pathology, in which general or spinal anesthesia could be associated with high risk of complications both during operation and in early postoperative period.

Keywords: TAP-block, anesthesia, hernia repair

Received: 12.12.2017


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